Provider Demographics
NPI:1770367146
Name:DYE, STEPHANIE TAYLOR (DMD, MS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:TAYLOR
Last Name:DYE
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DEE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:434 NW 25TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2689
Mailing Address - Country:US
Mailing Address - Phone:813-767-6921
Mailing Address - Fax:
Practice Address - Street 1:1395 CENTER DR RM D1-19
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3006
Practice Address - Country:US
Practice Address - Phone:352-273-7846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRPM2610122300000X
FLDN28577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist